Provider Demographics
NPI:1598372930
Name:HILL, WAMETA TANYA S
Entity Type:Individual
Prefix:
First Name:WAMETA TANYA
Middle Name:S
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BOGEY LN APT 6
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-8947
Mailing Address - Country:US
Mailing Address - Phone:501-502-8380
Mailing Address - Fax:
Practice Address - Street 1:4112 SUGAR MAPLE LN
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-2161
Practice Address - Country:US
Practice Address - Phone:501-508-3989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15983729303747A0650X
AR374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty